_____________________

FSD Document #
Outgoing Foreign Payment
Wire Transfer Request Print Form

Do Not Use - for Financial Services Department Only

COMPANY CODE
DATE If other than U of T COTR

PAYMENT CAD $
AMOUNT CURRENCY EQUIV
Name or Company

REQUIRED
Address - Number, Street and Apartment # or P.O. Box #
PAYEE INFORMATION
NOTE:
City, Province/State/Region, Postal Code Payee Phone Number
Payee name must be
the exact name of the
registered bank Country of Residence Enter payee e-mail here if they require a wire payment confirmation
account holder

Payee/Beneficiary Account #, IBAN or CLABE Bank Code (ABA, Routing #, SWIFT/BIC Code)

REQUIRED
Bank Name

BANK INFORMATION Address - Number, Street and Apartment # or P.O. Box #, City, Province/State/Region, Postal Code, Country

NOTE:
Payment Currency
must be the same
as beneficiary's
bank account Other required banking information(eg. Intermediary Bank information, CNY CNAPS Code, INR Currency Requirements)

Payment Details (i.e. Invoice#, Due Date of Wire Transfer)

ACCOUNTING INFORMATION (Required)

Business Internal Commitment
G/L Acct Tax Code Amount Area Cost Centre C/F Centre Fund
If other than 1000
Order Item

Total
For F Type Payment Only Vendor Number Document Number
Prepared By Department Email Address Telephone # Fax #

Authorized Approver (Print Name) Signature Title of Authorized Approver

* NOTES 1- Supporting documentation (e.g. invoice, contract, etc.) must be included with this wire request.
2- For Processing, ORIGINAL form MUST be sent to A/P Department, 215 Huron Street, 2nd Floor.
3- Prior to sending the ORIGINAL you can e-mail a completed copy of this form for review to: ap.fsd@utoronto.ca
4- Preparer and approver cannot be the same individual; approver must be one level up.
Do Not Use - for Financial Services Department Only
Approver Approver
New Existing
Payee Payee Order Number:

Financial Services Department FSD/V8.1.3/ 16/07/2014